Why Thailand risks getting its fingers burned in combating rise in smoking

From the Nation on 16 Oct 2018...interesting that it's even been published!
The parts in red font (by me) are of particular interest.

In the past 10 years, Thailand has attempted to curb smoking by enlarging the size of picture health warnings on cigarette packs repeatedly. Now, the gruesome photos cover up to 85 per cent of the packet. Yet the number of Thai smokers is increasing, figures show.

This incongruence ought to give Thai authorities pause to consider new ways to cut smoking.

The most successful policies globally have usually been slow but steady – public education about health effects tends to discourage older smokers while cost and taxation tend to discourage youth from taking up the habit. Over the past two decades, however, public health advocates have shifted their attention from reducing the health costs of smoking to undermining the tobacco industry itself.

This largely explains the newer anti-tobacco policies that we have seen being developed – tobacco control has moved beyond public education of smokers and potential smokers to “denormalisation” of smoking. But, of course, you can’t denormalise an activity, you can only denormalise people. Smokers have become social outcasts in many parts of the world.

Then there is the so-called plain packaging policy pioneered by Australia in 2012, which Thailand is now considering. This policy saw two changes simultaneously introduced Down Under. First the size of the graphic health warnings on packets was increased. Second, logos on the packet were banned and replaced by a standardised colour and fonts. Since 2012, France and the UK have also adopted this policy, and Singapore is considering following suit.

There are two questions to be considered when introducing any new policy. Will it actually work? Is it legal?

Looking at the second question, courts in both Australia and Britain have ruled that the policy is legal. It seems that intellectual property in those two countries can be expropriated without compensation. Investors beware. The WTO has recently ruled that the policy is not a violation of international IP conventions. That ruling is being appealed.

The more important question is whether the policy actually works. Just because a policy is legal doesn’t mean it is effective.

The evidence since December 2012, when the policy was first introduced, does not support the efficacy of plain packaging. In Australia the National Drug Strategy Household Survey, taken every three years, showed no statistically significant decline in smoking between 2013 and 2016. In fact due to population growth the number of smokers increased over that time. The Australian government’s own tracking study – the National Tobacco Plain Packaging Survey – commissioned to measure the impact of the policy did report that the policy was successful. But the WTO panel rubbished those claims, saying the evidence was “limited and mixed”. Even worse, in some parts, the National Tobacco Plain Packaging Survey results showed that the policy had exactly the opposite effect to the objectives.

Data collected by some Australian state health departments showed that smoking incidence rose after the introduction of plain packaging. Research published in the November 2017 issue of Tobacco Control showed an increase in youth smoking between 2010 and 2013. Similarly a November 2017 study in Tobacco Prevention & Cessation showed no statistically significant decline in youth smoking rates after the introduction of plain packaging.

While the Australian government is in denial over the failure of the plain packaging policy, the French health minister Agnes Buzyn has admitted that sales of tobacco products increased after the introduction of plain packaging in France. In the UK the Office for National Statistics reported an increase in smoking prevalence in the first year of plain packaging in that country.

In the meantime there has been a huge increase in smuggling and counterfeiting of cigarettes. Plain packaging has made the jobs of criminals easier, while excise tax increases have made it more profitable too. Unsurprisingly the process of denormalisation has made smokers more willing to engage with the black economy. Tobacco control has lost its way. The attempt to engage the industry rather than the health consequences of smoking has resulted in the recent failures and perhaps even an increase in smoking.

The solution to failure is not to redouble your efforts, but to change course. The single largest contributor to reduced smoking rates in the UK – until the failed plain packaging policy was adopted – was the mainstreaming of electronic nicotine delivery devices. Alternate mechanisms to deliver nicotine to smokers sees many smokers substitute away from combustible tobacco products to safer products and in some cases to quitting altogether.

The Thai government should consider these findings as it looks at plain packaging as a potential solution. Unlike Australia, France and the UK, Thailand is a developing country. A policy which compromises its intellectual property protection would inevitably lead to a loss of confidence from foreign investors, hurting Thailand’s economy more than the developed nations.

A better solution for Thailand would be to emulate Japan’s emphasis on education, teaching children from early age of the dangers of smoking. It is not a quick fix, of course. But if Thailand wants to lower the prevalence of smoking it should not follow the fashionable, but failed, plain packaging policies of Australia, France and the UK.

Sinclair Davidson is a professor of economics at RMIT University in Melbourne Australia.